Skip to main content

Advertisement

Log in

Drug Use, High-Risk Sex Behaviors, and Increased Risk for Recent HIV Infection among Men who Have Sex with Men in Chicago and Los Angeles

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We examined how drugs, high-risk sexual behaviors, and socio-demographic variables are associated with recent HIV infection among men who have sex with men (MSM) in a case–control study. Interviewers collected risk factor data among 111 cases with recent HIV infection, and 333 HIV-negative controls from Chicago and Los Angeles. Compared with controls, cases had more unprotected anal intercourse (UAI) with both HIV-positive and HIV-negative partners. MSM with lower income or prior sexually transmitted infections (STI) were more likely to be recently HIV infected. Substances associated with UAI included amyl nitrate (“poppers”), methamphetamine, Viagra® (or similar PDE-5 inhibitors), ketamine, and gamma hydroxybutyrate (GHB). Cases more frequently used Viagra®, poppers, and methamphetamine during UAI compared with controls. In multivariate analysis, income, UAI with HIV-positive partners, Viagra®, and poppers remained associated with recent HIV seroconversion. Better methods are needed to prevent HIV among MSM who engage in high-risk sex with concurrent drug use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Benotsch, E. G., Nettles, C. D., & Kalichman, S. C. (2005). Methamphetamine use, sensation seeking, and high-risk sexual behavior among men who have sex with men. Poster presented at the 26th annual meeting of the Society of Behavioral Medicine. Boston, MA. Abstract available at: http://www.sbm.org/meeting/2005/05annualmeeting.htm.

  • Boerma, J. T., & Weir, S. S. (2005). Integrating demographic and epidemiological approaches to research HIV/AIDS: The proximate determinants framework. Journal of Infectious Diseases, 191, S61–S67.

    Article  PubMed  Google Scholar 

  • Buchacz, K., McFarland, W., Kellogg, T. A., Loeb, L., Holmberg, S. D., Dilley, J., et al. (2005). Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco. AIDS, 19, 1423–1424.

    Article  PubMed  Google Scholar 

  • Buchbinder, S. P., Vittinghoff, E., Heagerty, P. J., Celum, C. L., Seage, G., Judson, F. N., et al. (2005). Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. Journal of Acquire Immune Deficiency Syndromes, 39, 82–89.

    Article  Google Scholar 

  • Catania, J. A., Osmond, D., Stall, R. D., Pollack, L., Paul, J. P., Blower, S., et al. (2001). The continuing HIV epidemic among men who have sex with men. American Journal of Public Health, 91, 907–914.

    Article  CAS  PubMed  Google Scholar 

  • CDC. (2005). HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—five U.S. cities, June 2004-April. Morbidity and Mortality Weekly Report, 54, 597–601.

    Google Scholar 

  • CDC. (2007). HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev. Ed. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention.

  • Celentano, D. D., Valleroy, L. A., Sifakis, F., MacKellar, D. A., Hylton, J., Thiede, H., et al. (2006). Associations between substance use and sexual risk among very young men who have sex with men. Sexually Transmitted Diseases, 33, 265–271.

    PubMed  Google Scholar 

  • Chesney, M. A., Barrett, D. C., & Stall, R. (1998). Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men. American Journal of Public Health, 88, 113–116.

    Article  CAS  PubMed  Google Scholar 

  • Chou, R., Huffman, L. H., Fu, R., Smits, A. K., & Korthuis, P. T. (2005). Screening for HIV: A review of the evidence for the U.S. Preventive Task Force. Annals of Internal Medicine, 143, 55–73.

    PubMed  Google Scholar 

  • Chu, P. L., McFarland, W., Gibson, S., Weide, D., Henne, J., Miller, P., et al. (2003). Viagra use in a community-recruited sample of men who have sex with men, San Francisco. Journal of Acquired Immune Deficiency Syndromes, 33, 191–193.

    Article  PubMed  Google Scholar 

  • Colfax, G., Coates, T. J., Husnik, M. J., Huang, Y., Buchbinder, S., Koblin, B., et al. (2005). Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. Journal of Urban Health, 82(Suppl.1), i62–i70.

    PubMed  Google Scholar 

  • Drumright, L. N., Little, S. J., Strathdee, S. A., Slymen, D. J., Araneta, M. R. G., Malcarne, V. L., et al. (2006a). Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. Journal of Acquired Immune Deficiency Syndromes, 43, 344–350.

    Article  PubMed  Google Scholar 

  • Drumright, L. N., Patterson, T. L., & Strathdee, S. A. (2006b). Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review. Substance Use and Misuse, 41, 1551–1601.

    Article  PubMed  Google Scholar 

  • Fenton, K. A., & Valdiserri, R. O. (2006). Twenty-five years of HIV/AIDS—United States, 1981–2006. Morbidity and Mortality Weekly Report, 55, 585–589.

    Google Scholar 

  • Giancola, P. R., & Tarter, R. (1999). Executive cognitive functioning and risk for substance abuse. Psychology Science, 10, 203–207.

    Article  Google Scholar 

  • Gibson, D. R., Flynn, N. M., & McCarthy, J. J. (1999). Effectiveness of methadone treatment in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS, 13, 1807–1818.

    Article  CAS  PubMed  Google Scholar 

  • Greenwald, J. L., Rich, C. A., Bessega, S., Posner, M., Maeda, J. L., & Skolnik, P. R. (2006). Evaluation of the Centers for Disease Control and Prevention’s recommendations regarding routine testing for human immunodeficiency virus by an inpatient service: Who are we missing? Mayo Clinic Procedures, 81, 452–458.

    Article  Google Scholar 

  • Halkitis, P. N., Green, K. A., & Mourgues, P. (2005). Longitudinal investigation of methamphetamine use among gay and bisexual men in New York City: Findings from Project BUMPS. Journal of Urban Health, 82(Suppl. 1), i18–i25.

    PubMed  Google Scholar 

  • Herbst, J. H., Sherba, R. T., Crepaz, N., Deluca, J. B., Zohrabyan, L., Stall, R. D., et al. (2005). A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. Journal of AIDS, 39, 228–241.

    PubMed  Google Scholar 

  • Hirshfield, S., Remien, R. H., Humberstone, M., Walavalkar, I., & Chiasson, M. A. (2004). Substance use and high-risk sex among men who have sex with men: A national online study in the USA. AIDS Care, 16, 1036–1047.

    Article  CAS  PubMed  Google Scholar 

  • Janssen, R. S., Satten, G. A., Stramer, S. L., Rawal, B. D., O’Brien, T. R., Weiblen, B. J., et al. (1998). New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. Journal of the American Medical Association, 280, 42–48.

    Article  CAS  PubMed  Google Scholar 

  • Kim, A. A., Kent, C. K., & Klausner, J. D. (2002). Increased risk of HIV and sexually transmitted disease transmission among gay or bisexual men who use Viagra, San Francisco 2000–2001. Journal of Acquired Immunodeficiency Syndromes, 16, 1425–1428.

    Google Scholar 

  • Kleinbaum, D. G. (2002). Epidemiologic methods: the “art” in the state of the art. Journal of Clinical Epidemiology, 55, 1196–1200.

    Article  PubMed  Google Scholar 

  • Koblin, B. A., Husnik, M. J., Colfax, G., Huang, Y., Madison, M., Mayer, K., et al. (2006). Risk factors for HIV infection among men who have sex with men. Journal of Acquired Immunodeficiency Syndromes, 20, 731–739.

    Google Scholar 

  • Kothe, D., Byers, R. H., Caudill, S. P., Satten, G. A., Janssen, R. S., Hannon, W. H., et al. (2003). Performance characteristics of a new less sensitive HIV-1 enzyme immunoassay for use in estimating HIV seroincidence. Journal of Acquired Immune Deficiency Syndromes, 33, 625–634.

    Article  CAS  PubMed  Google Scholar 

  • Leigh, B. C., & Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV: Issues in methodology, interpretation, and prevention. American Psychologist, 48, 1035–1045.

    Article  CAS  PubMed  Google Scholar 

  • Loeb, L. (2004). Viagra: the science and politics of drugs, sex, and risk. Focus, 19, 4–7.

    PubMed  Google Scholar 

  • MacDonald, N., Elam, G., Hickson, F., Imrie, J., McGarrigle, C. A., Fenton, K. A., et al. (2008). Factors associated with HIV seroconversion in gay men in England at the start of the 21st century. Sexually Transmitted Infections, 84, 8–13.

    Article  CAS  PubMed  Google Scholar 

  • Mansergh, G., Shouse, R. L., Marks, G., Guzman, R., Rader, M., Buchbinder, S., et al. (2006). Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men. Sexually Transmitted Infections, 82, 131–134.

    Article  CAS  PubMed  Google Scholar 

  • Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes, 39, 446–453.

    Article  PubMed  Google Scholar 

  • Mausbach, B. T., Semple, S. J., Strathdee, S. A., Zians, J., & Patterson, T. L. (2007). Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: Results from the EDGE study. Drug and Alcohol Dependence, 87, 249–257.

    Article  PubMed  Google Scholar 

  • McKirnan, D. G., Ostrow, B. H., & Hope, B. (1996). Sex, drugs and escape: A psychological model of HIV-risk sexual behaviours. AIDS Care, 8, 655–669.

    Article  CAS  PubMed  Google Scholar 

  • McNal, M., & Remafedi, G. (1999). Relationship of amphetamine and other substance use to unprotected intercourse among young men who have sex with men. Archives of Pediatric and Adolescence Medicine, 153, 1130–1135.

    Google Scholar 

  • Metzger, D. S., & Navaline, H. (2003). Human immunodeficiency virus prevention and the potential of drug abuse treatment. Clinical Infectious Diseases, 37(Suppl. 5), S451–S456.

    Article  PubMed  Google Scholar 

  • Metzger, D. S., Navaline, H., & Woody, G. E. (1998). Drug abuse treatment as AIDS prevention. Public Health Reports, 113(Suppl. 1), 97–106.

    PubMed  Google Scholar 

  • Metzger, D. S., Woody, G. E., McLellan, A. T., O’Brien, C. P., Druley, P., Navaline, H., et al. (1993). Human immunodeficiency virus seroconversion among in- and out-of-treatment intravenous drug users: An 18-month prospective follow-up. Journal of Acquired Immune Deficiency Syndromes, 6, 1049–1056.

    CAS  PubMed  Google Scholar 

  • Molitor, F., Truax, S. R., Ruiz, J. D., & Sun, R. K. (1998). Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western Journal of Medicine, 168, 93–97.

    CAS  PubMed  Google Scholar 

  • Mustanski, B. (2008). Moderating effects of age on the alcohol and sexual risk taking association: An online daily diary study of men who have sex with men. AIDS and Behavior, 12, 118–126.

    Article  PubMed  Google Scholar 

  • Nagelkerke, N. J. D. (1991). A note on a general definition of the coefficient of determination. Biometrika, 78, 691–692.

    Article  Google Scholar 

  • Newman, P. A., Rhodes, F., & Weiss, R. E. (2004). Correlates of sex trading among drug-using men who have sex with men. American Journal of Public Health, 94, 1998–2003.

    Article  PubMed  Google Scholar 

  • Ostrow, D. G., Beltran, E. D., Joseph, J. G., DiFranceisco, W., Wesch, J., & Chmiel, J. S. (1993). Recreational drugs and sexual behavior in the Chicago MACS/CCS cohort of homosexually active men. Journal of Substance Abuse, 5, 311–325.

    Article  CAS  PubMed  Google Scholar 

  • Patterson, T. L., Semple, S. J., Zians, J. K., & Strathdee, S. A. (2005). Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use. Journal of Urban Health, 82(Suppl. 1), i120–i126.

    PubMed  Google Scholar 

  • Paul, J. P., Pollack, L., Osmond, D., & Catania, J. A. (2005). Viagra (sildenafil) use in a population-based sample of U.S. men who have sex with men. Sexually Transmitted Diseases, 32, 531–533.

    Article  PubMed  Google Scholar 

  • Plankey, M. W., Ostrow, D. G., Stall, R., Cox, C., Li, X., Peck, J. A., et al. (2007). The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndromes, 45, 85–92.

    Article  CAS  PubMed  Google Scholar 

  • Purcell, D. W., Moss, S., Remien, R. H., Woods, W. J., & Parsons, J. T. (2005a). Illicit substance use, sexual risk, and HIV-positive gay and bisexual men: differences by serostatus of casual partners. Journal of Acquired Immunodeficiency Syndromes, 19(Suppl. 1), S37–S47.

    Google Scholar 

  • Purcell, D. W., Parsons, J. T., Halkitis, P. N., Mizuno, Y., & Woods, W. J. (2001). Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse, 13, 185–200.

    Article  CAS  PubMed  Google Scholar 

  • Purcell, D. W., Wolitski, R. J., Hoff, C. C., Parsons, J. T., Woods, W. J., & Halkitis, P. N. (2005b). Predictors of the use of viagra, testosterone, and antidepressants among HIV-seropositive gay and bisexual men. Journal of Acquired Immunodeficiency Syndromes, 19, S57–S66.

    CAS  Google Scholar 

  • Rawal, B. D., Regula, A., Lebedeva, L., Janssen, R. S., Hecht, F. M., Sheppard, H. W., et al. (2003). Development of a new less-sensitive enzyme immunoassay for detection of early HIV-1 infection. Journal of Acquired Immune Deficiency Syndromes, 33, 349–355.

    CAS  PubMed  Google Scholar 

  • Romanelli, F., & Smith, K. M. (2004). Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males. Annals of Pharmacotherapy, 38, 1024–1030.

    Article  CAS  PubMed  Google Scholar 

  • Rosen, R. C., Catania, J. A., Ehrhardt, A. A., Burnett, A., Lue, T., McKenna, K., et al. (2006). The Bolger Conference on PDE-5 Inhibition and HIV risk: implications for health policy and prevention. Journal of Sexual Medicine, 3, 960–975.

    Article  CAS  PubMed  Google Scholar 

  • Sanchez, T., Finlayson, T., Drake, A., Behel, S., Cribbin, M., DiNenno, E., et al. (2006). Human immunodeficiency virus (HIV) risk, prevention, testing behaviors—United States, National HIV Behavioral Surveillance System: Men who have sex with men, November 2003–April 2005. Morbidity and Mortality Weekly Reports: Surveillance Summaries, 55(SS6), 1–16.

    Google Scholar 

  • Sanchez, T. H., & Gallagher, K. M. (2006). Factors associated with recent sildenafil (Viagra) use among men who have sex with men in the United States. Journal of Acquired Immunodeficiency Syndromes, 42, 95–100.

    Article  Google Scholar 

  • Schlesselman, J. J. (1982). Case–control studies: Design, conduct, analysis. New York: Oxford University Press.

    Google Scholar 

  • Shoptaw, S., & Reback, C. J. (2007). Methamphetamine use and infectious disease-related behaviors in men who have sex with men: Implications for interventions. Addiction, 102(Suppl. 1), 130–135.

    Article  PubMed  Google Scholar 

  • Shoptaw, S., Reback, C. J., Peck, J. A., Yang, X., Rotheram-Fuller, E., Larkins, S., et al. (2005). Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug and Alcohol Dependence, 78, 125–134.

    Article  PubMed  Google Scholar 

  • Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., et al. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942.

    Article  PubMed  Google Scholar 

  • Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., et al. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction, 96, 1589–1601.

    Article  CAS  PubMed  Google Scholar 

  • Stall, R., & Purcell, D. W. (2000). Intertwining epidemics: A review in research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS and Behavior, 4, 181–192.

    Article  Google Scholar 

  • Strathdee, S. A., & Sherman, S. G. (2003). The role of sexual transmission of HIV infection among injection and non-injection drug users. Journal of Urban Health, 80(Suppl.3), iii7–iii14.

    PubMed  Google Scholar 

  • Swearingen, S. G., & Klausner, J. D. (2005). Sildenafil use, sexual risk behavior, and risk for sexually transmitted diseases, including HIV infection. American Journal of Medicine, 118, 571–577.

    Article  CAS  PubMed  Google Scholar 

  • Thiede, H., Jenkins, R. A, Carey, J. W., Hutcheson, R., Thomas, K. K., Stall, R., White, E., Allen, I., Mejia, R., and Golden, M. (2008). Determinants of recent HIV infection among Seattle-area men who have sex with men. American Journal Public Health (in press).

  • Thiede, H., Valleroy, L. A., MacKellar, D. A., Celentano, D. D., Ford, W. L., Hagan, H., et al. (2003). Regional patterns and correlates of substance use among young men who have sex with men in 7 US urban areas. American Journal of Public Health, 93, 1915–1921.

    Article  PubMed  Google Scholar 

  • Wolitski, R. J., Henny, K. D., Lyles, C. M., Purcell, D. W., Carey, J. W., Crepaz, N., et al. (2006). Evolution of HIV/AIDS prevention programs—United States, 1981–2006. Morbidity and Mortality Weekly Reports, 55, 597–603.

    Google Scholar 

Download references

Acknowledgements

The authors thank Stephanie Behel, Steve Jones, Elise Levin, Kristina Bowles, Duncan MacKellar, Vel McKleroy, Michael Plankey, David Purcell, John Sheridan, Laura Syster, Stephen Tregear, and Patrick Wenzel. We also thank the staff at the health departments in Chicago and Los Angeles, the HIV/AIDS program clinics assisting our investigation, and our study participants. This study was funded by CDC cooperative agreement number 00005b, as part of the “Context of HIV Infection Project (CHIP).

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily reflect the views of the Centers for Disease Control and Prevention (CDC).

Funding Source

Centers for Disease Control and Prevention.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James W. Carey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carey, J.W., Mejia, R., Bingham, T. et al. Drug Use, High-Risk Sex Behaviors, and Increased Risk for Recent HIV Infection among Men who Have Sex with Men in Chicago and Los Angeles. AIDS Behav 13, 1084–1096 (2009). https://doi.org/10.1007/s10461-008-9403-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-008-9403-3

Keywords

Navigation